50 Things New Nurses Need to Know about Orientation
Orientation is meant to get a nurse ready for life on the floor, but it can be a gut check that nursing school is not. It is a culture shock and hits everyone differently. If you are going through this, will go through this, or remember going through this, then you should read this article.New nurse orientation is one of the most eye opening experiences in becoming a nurse. You shift from being coddled to experiencing what the real world is like. Even nurses who change jobs have difficulty with orientation because nursing is so detail oriented. If you are a new nurse or a nurse changing jobs, here are some tips for making it a little easier.
1) You will be overwhelmed. Expect it.
2) Nursing school taught you the basics, but orientation teaches you how to be a nurse.
3) Always be honest with your preceptor.
4) Don’t be afraid to jump in and help if you are sure you know what you’re doing.
5) Answer bells. Always.
6) Study the policies and procedures manual. They will come up at some point.
7) Don’t be afraid to admit you don’t get something.
8) Follow the watch, do, teach model of learning a new skill.
9) Be brave when trying new things that are asked of you.
10) You will have far more patients than in school, and this can be scary.
11) Get a brain sheet that works for you, not just for your preceptor.
12) Talk to your manager about how things are going in your orientation.
13) Don’t compare yourself to other new grads because people learn differently.
14) Try to observe as much nursing care as possible, even if it isn’t your patient.
15) Rotate to other departments that impact your own to get a feel for the other side.
16) You don’t need to know everything the first day.
17) Chart as you go.
18) Let your preceptor look over your charting to ensure you are doing it right.
19) Get to know your floor’s education specialist.
20) Take every opportunity to do mock codes or use simulators.
21) Don’t do everything yourself. Learn the nuances of delegation.
22) Make friends with your fellow nurses and CNAs. You will need them.
23) Your charge nurse is your friend. You will turn to them when you are alone and confused.
24) Learn the most common drugs on your floor: generic name, actions, side effects, and so on.
25) Take any classes or seminars you are offered.
26) Be sure to go through your skills checkoff sheet, and ensure you are comfortable with the skills.
27) If someone needs an IV started, volunteer to try.
28) Spend a half shift with the same day surgery pre-op nurse to learn how to start a ton of IVs in a short period of time.
29) Get to know your crash cart, how to work the equipment, and what is on it.
30) Don’t be afraid to ask for a new preceptor if you aren’t gelling with your current one.
31) Use your nursing textbooks to brush up on skills you are using on the floor.
32) Take your NCLEX. NOW.
33) Find a nurse that you admire and befriend them. Ask them to become your mentor.
34 Learn the ins and outs of different shifts on your floor. You will be working them.
35) Don’t stay after every shift for hours on end.
36) When you go home, spend some time studying, but mostly just rest.
37) It’s okay to cry in your car on the way home.
38) Be prepared to hate nursing for a little while. This is normal and will pass.
39) Learn how to use all the equipment on your floor: O2 nozzles, IV pumps, the bed, suction, lights, and anything else you use frequently.
40) Don’t increase your patient load until you and your preceptor feel you are ready.
41) Get to know the doctors as well as you can so you can work with them.
42) Don’t be intimidated by cranky people: patients, doctors, coworkers, or supervisors.
43) Try to memorize the most common extensions you use, like the lab, the pharmacy, other departments, and the most called doctors.
44) Spend some time looking through the medical record online to keep track of recent orders, doctor’s notes, and radiology results.
45) Shadow the unit clerk for a day to understand how the medical data is inputted and processed for admissions, orders, and discharges.
46) Get into the habit of reading the bulletin board in the breakroom for policy changes.
47) Learn how to lift safely and always use correct lifting procedures.
48) Decompress with other nurses to get your fears and triumphs off your chest.
49) Don’t freak out if you have an emergency on orientation. Your preceptor is there to guide you through and other nurses will almost always help.
50) Take lunch, go to the bathroom, get off your feet, and allow yourself to breathe every now and again. We've all gone through orientation and survived. So will you.
Does anyone else have orientation horror stories or tips for new grads? Every bit of encouragement helps, so if you can think of something this list failed to mention, please post it in the comments. It may help a nurse adjust to their new surroundings.Last edit by Joe V on Oct 20, '17
About Lynda Lampert, RN
Joined: Apr '06; Posts: 99; Likes: 655
Freelance Medical Writer; from US
Specialty: 4 year(s) of experience in telemetry, med-surg, post op, ICUJan 29, '15I can't stress enough the use of a brain sheet and getting down a way YOU like to organize your information. I had a brain sheet and would make notes on it then highlight things as I charted it. Then I knew what was and wasn't charted yet.
Also the not getting intimidated by cranky people. There are some doctors who just don't....get it. They are cranky and can be mean and may make you cry. The other nurses know what they're like so just do what you can.
AND take some time if you need after your first death. I still remember mine. I had to go spend some time in the bathroom. It was very unexpected but she was a DNR. I had just given her Lasix about 30 minutes before (and she was talking and visiting) and one of the docs had just seen her right before the Lasix. He was baffled along with me. I started tearing up in the patient's room and I had family comforting ME. You can't save everyone. Unexpected things will happen. Just take the time to deal with it.Jan 29, '15One of the things I fear as a new grad is communicating with and calling doctors. That's not a skill they teach you in nursing school. Does your preceptor address this skill? Or are we expected to figure it out? The newer and younger docs coming out of med school seem to be more friendly and cooperative than some of the older ones (there are some nice older ones too though), so maybe the whole "mean doc" thing is dying more these days...Jan 29, '15Quote from H4ywiiLearn how to communicate using SBAR when talking to anyone and everyone; being straight to the point has helped with ANY doctor.One of the things I fear as a new grad is communicating with and calling doctors. That's not a skill they teach you in nursing school. Does your preceptor address this skill? Or are we expected to figure it out? The newer and younger docs coming out of med school seem to be more friendly and cooperative than some of the older ones (there are some nice older ones too though), so maybe the whole "mean doc" thing is dying more these days...
Sticking to SBAR gives the message, even if the person reviving the message is receptive, snarky, whatever.
Here are a few examples here:
Practice Pointers: Speak SBAR to improve communication
As well as examples on YouTube:
https://m.youtube.com/results?q=sbar&sm=1Jan 29, '15Thanks! I'll check those out and start practicing from the get go so I'll have SBAR communication down pat as a habit!Jan 29, '15Even in the Ed where there are multiple docs to go to, I have learned to always go with a recommendation. Sometimes the doc discounts it, and gives/doesn't give another order. We are really team oriented so I can always ask why. I usually receive a great teaching moment.
When I don't I bounce it off another more experienced nurse. At that point I either get a teaching moment or we go back to the doc, and they get a teaching moment. I work in a teaching hospital so nobody really looks down their nose at people asking questions, unless it's the same question for the third time tonight...
BSN GCU 2014. ED Residency
Sent from my iPhone using allnursesJan 30, '15Don't accuse the preceptor of not following nursing practice unless it's super flagrant and you are sure you are correct. Even though you think you learned everything in school, do not treat your preceptor like she's done something illegal because you didn't know the real life application.
Don't tell the orientor that she doesn't know what she's doing. Just say ok and approach a manager or DON later about your querie in a non accusational manner.Jan 30, '15Quote from H4ywiiAnother bit of advice I have when contacting doctors is check a recent set of vitals before you call, because they will probably ask. And don't just check heart rate or blood pressure- "check one, check 'em all."Thanks! I'll check those out and start practicing from the get go so I'll have SBAR communication down pat as a habit!Jan 30, '15Be kind to your feet, you are going to need them! Compression stockings are not just for patients, buy a few pair, and wear them. Never go to work a 12 hour shift with only one pair of shoes! Changing shoes half way through a shift gives your feet a break and feels really really good!!Jan 30, '15This article and the below comments are very helpful. I've been nursing for about 7 months but I haven't had time or proper orientation. So I'm trying to use the current facility and learn as much as I can although it's not a great place to learn honestly. This will definitely help me a lot and future new grads, preceptors, and job changing nurses.Last edit by GodMinistryNurse on Jan 30, '15 : Reason: spelled wrongJan 30, '15Thankyou for this article I am a new grad just finished my second day, on a busy acute ward. And honestly I feel useless, I had 5 pts and needed help to get get everything done, when i was a student everyone used a shift planner which beame my little mini bible for the shift but here no one does and they look at my strangly when I go back to look at it. DOnt get me wrong I am thrilled to get this grad yr, but I feel like I have more spent more time the last few days worrying about things i need to do than doing it, any tips would be great!!Jan 30, '15Quote from Lil_chickenSo WHAT they look at you strangely; have the confidence to use it for YOUR benefit; so continue using your brain sheet and if you get everything done, great...remember it your practice on the line; no one else can do YOUR nursing practice for you.Thankyou for this article I am a new grad just finished my second day, on a busy acute ward. And honestly I feel useless, I had 5 pts and needed help to get get everything done, when i was a student everyone used a shift planner which beame my little mini bible for the shift but here no one does and they look at my strangly when I go back to look at it. DOnt get me wrong I am thrilled to get this grad yr, but I feel like I have more spent more time the last few days worrying about things i need to do than doing it, any tips would be great!!Jan 30, '15I totally agree with this list.
I would add that a lot of the doctors I have dealt with are a little more reserved until you have proven yourself to them. You can always tell once you've met their approval, because they are a lot more open and relaxed. It might be as simple as suggesting a medication or coming up with something they hadn't thought of.
One of our docs will quiz the nurses about meds and labs. It's his way of getting a baseline on the nurse and figuring out a trust level. He also turns everything into teaching moments, which is really helpful in return.
Along with the brain sheet, make out a mini schedule for the first few shifts. Break it down into 1 hour periods and use it to lay out your day at the beginning of the shift. It helps as a frame of reference for trying to stay on task. Even write in time for charting, for what you can't get done in the room. It will help you get into a habit of organizing your day.
My absolute, #1 tip though...DON'T LOSE YOUR BRAINS!!! (the piece of paper with all your notes for the day)!
You will look silly as you are looking in garbage cans and patients beds for that insanely important piece of paper. Don't feel bad though, everyone has done it multiple times before and you will too!
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